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目的探讨431例慢性乙型肝炎病毒感染者临床指标与肝脏炎症和纤维化程度的相关性。方法将431例患者分为4组,观察不同谷丙转氨酶(alanine transaminase,ALT)组肝脏GS分期的差异,进一步分析各组患者GS分期与其他临床指标的关系。结果不同ALT水平患者组间GS分级差异均有统计学意义(均有P<0.05),ALT在20~40 U/L和40~80 U/L的患者中G2~4的比例分别为30.62%和35.47%,S2~4的比例则为49.24%和49.42%。不同G分级患者组间球蛋白(globulin,GLB)、谷草转氨酶(aspartate transaminase,AST)、谷氨酰转肽酶(glutamyltranspeptidase,GGT)、血小板(platelet,PLT)水平和天门冬氨酸氨基转移酶/血小板比值指数(aspartate aminotransferase platelet ratio index,APRI)差异均有统计学意义(均有P<0.05);不同S分期患者组间年龄、白蛋白(albumin,ALB)、AST、PLT、HBV DNA、APRI的差异均有统计学意义(均有P<0.05)。HBV DNA水平和APRI指数是肝纤维化程度的独立预测因素。结论慢性乙型肝炎病毒(hepatitis B virus,HBV)感染者即使ALT小于2倍正常值上限(upper limit of normal,ULN),但部分患者仍有明显肝组织炎症和纤维化进展,这些患者必须结合年龄、AST、GGT、APRI、HBeAg状态和HBV DNA水平进行评估是否需要抗病毒治疗,必要时须行肝脏穿刺病理检查。
Objective To investigate the correlation between the clinical indexes of 431 cases of chronic hepatitis B virus infection and the degree of liver inflammation and fibrosis. Methods 431 patients were divided into 4 groups to observe the differences of hepatic GS staging among different groups of alanine transaminase (ALT). The relationship between GS staging and other clinical indexes was further analyzed. Results There was significant difference in the grade of GS among patients with different levels of ALT (all P <0.05). The proportion of G2 ~ 4 in ALT between 20 ~ 40 U / L and 40 ~ 80 U / L was 30.62% And 35.47% respectively, while the proportion of S2 ~ 4 was 49.24% and 49.42% respectively. The levels of globulin (GLB), aspartate transaminase (AST), glutamyltranspeptidase (GGT), platelet (PLT) and aspartate aminotransferase / Aspartate aminotransferase platelet ratio index (APRI) were significantly different (all P <0.05); age, albumin (ALB), AST, PLT, HBV DNA, APRI differences were statistically significant (both P <0.05). HBV DNA level and APRI index are independent predictors of the degree of liver fibrosis. Conclusions Even though ALT is less than 2 times upper limit of normal (ULN) in patients with chronic hepatitis B virus (HBV) infection, some patients still have obvious liver inflammation and fibrosis progression. These patients must be combined Age, AST, GGT, APRI, HBeAg status, and HBV DNA levels were assessed for antiviral therapy and liver biopsy if necessary.